Highlights
- •Meta-analysis of 26 non-randomized studies comparing robotic, laparoscopic, and abdominal radical hysterectomy for women with stage IA1–IIA cervical cancer.
- •Robotic radical hysterectomy was associated with less estimated blood loss, febrile morbidity, and shorter hospital stay compared to abdominal approach.
- •Robotic radical hysterectomy and laparoscopic radical hysterectomy appear equivalent in intraoperative and short-term postoperative outcomes.
Abstract
Objective
To compare intraoperative and short-term postoperative outcomes of robotic radical
hysterectomy (RRH) to laparoscopic and open approaches in the treatment of early stage
cervical cancer.
Methods
A search of MEDLINE, EMBASE (using Ovid interface) and SCOPUS databases was conducted
from database inception through February 15, 2014. We included studies comparing surgical
approaches to radical hysterectomy (robotic vs. laparoscopic or abdominal, or both)
in women with stages IA1–IIA cervical cancer. Intraoperative outcomes included estimated
blood loss (EBL), operative time, number of pelvic lymph nodes harvested and intraoperative
complications. Postoperative outcomes were hospital stay and surgical morbidity. The
random effects model was used to pool weighted mean differences (WMDs) and odds ratios
(OR).
Results
Twenty six nonrandomized studies were included (10 RRH vs abdominal radical hysterectomy
[ARH], 9 RRH vs laparoscopic radical hysterectomy [LRH] and 7 compared all 3 approaches)
enrolling 4013 women (1013 RRH, 710 LRH and 2290 ARH). RRH was associated with less
EBL (WMD = 384.3, 95% CI = 233.7, 534.8) and shorter hospital stay (WMD = 3.55, 95% CI = 2.10, 5.00) than ARH. RRH was also associated with lower odds of febrile morbidity
(OR = 0.43, 95% CI = 0.20–0.89), blood transfusion (OR = 0.12, 95% CI 0.06, 0.25) and wound-related complications (OR = 0.31, 95% CI = 0.13, 0.73) vs. ARH. RRH was comparable to LRH in all intra- and postoperative outcomes.
Conclusion
Current evidence suggests that RRH may be superior to ARH with lower EBL, shorter
hospital stay, less febrile morbidity and wound-related complications. RRH and LRH
appear equivalent in intraoperative and short-term postoperative outcomes and thus
the choice of approach can be tailored to the choice of patient and surgeon.
Keywords
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References
- Worldwide trends in cervical cancer incidence: impact of screening against changes in disease risk factors.Eur. J. Cancer. 2013; 49 (10//): 3262-3273
- American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer.CA Cancer J. Clin. 2012; 62: 147-172
- Laparoscopic radical hysterectomy for invasive cervical cancer: 8-year experience of a pilot study.Gynecol. Oncol. 2003; 91 (12//): 534-539
- Laparoscopic surgery in gynecologic oncology.Surg. Clin. N. Am. 2001; 81: 949-964
- Finnish national register of laparoscopic hysterectomies: a review and complications of 1165 operations.Am. J. Obstet. Gynecol. 1997; 176 (1//): 118-122
- Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials.BMJ. 2005; 330: 1478
- Laparoscopic treatment for endometrial cancer: a meta-analysis of randomized controlled trials (RCTs).Gynecol. Oncol. 2009; 112 (2//): 415-421
- Robotic radical hysterectomy.Am. J. Obstet. Gynecol. 2008; 198 (6//): 649.e1-649.e4
- Robot‐assisted surgery in cervical cancer patients reduces the time to normal activities of daily living.Acta Obstet. Gynecol. Scand. 2015; 94: 260-265
- A case–control study of robot-assisted type III radical hysterectomy with pelvic lymph node dissection compared with open radical hysterectomy.Am. J. Obstet. Gynecol. 2008; 199: 357.e1-357.e7
- Survival outcomes for women undergoing type III robotic radical hysterectomy for cervical cancer: A 3-year experience.Gynecol. Oncol. 2010; 117 (5//): 260-265
- Comparing robotic surgery with conventional laparoscopy and laparotomy for cervical cancer management.Int. J. Gynecol. Cancer. 2014; 24: 1105-1111
- Robot versus laparoscopic nerve-sparing radical hysterectomy for cervical cancer: a comparison of the intraoperative and perioperative results of a single surgeon's initial experience.Int. J. Gynecol. Cancer. 2013; 23: 1145-1149
- Mini-laparoscopic versus robotic radical hysterectomy plus systematic pelvic lymphadenectomy in early cervical cancer patients. A multi-institutional study.Eur. J. Surg. Oncol. 2015; 41: 136-141
- Overall care cost comparison between robotic and laparoscopic surgery for endometrial and cervical cancer.Eur. J. Obstet. Gynecol. Reprod. Biol. 2013; 171: 348-352
- A case matched analysis of robotic radical hysterectomy with lymphadenectomy compared with laparoscopy and laparotomy.Gynecol. Oncol. 2009; 113: 357-361
- Robotically assisted laparoscopic radical hysterectomy compared with open radical hysterectomy.Int. J. Gynecol. Cancer. 2010; 20: 438-442
- Robot-assisted radical hysterectomy—perioperative and survival outcomes in patients with cervical cancer compared to laparoscopic and open radical surgery.Gynecol. Surg. 2012; 9: 81-88
- Robotic radical hysterectomy: comparison of outcomes and cost.J. Robot. Surg. 2010; 4: 211-216
- Robotic versus laparoscopic radical hysterectomy in cervical cancer patients: a matched-case comparative study.Int. J. Gynecol. Cancer. 2014; 24: 1466-1473
- Robotic versus open radical hysterectomy: a comparative study at a single institution.Gynecol. Oncol. 2008; 111: 425-430
- A comparison of robot-assisted and traditional radical hysterectomy for early-stage cervical cancer.J. Robot. Surg. 2009; 3: 19-23
- Robotic approach for cervical cancer: comparison with laparotomy: a case control study.Gynecol. Oncol. 2009; 115: 60-64
- Robotic radical hysterectomy: comparison with laparoscopy and laparotomy.Gynecol. Oncol. 2008; 109: 86-91
- A case–control study of robotic radical hysterectomy and pelvic lymphadenectomy using 3 robotic arms compared with abdominal radical hysterectomy in cervical cancer.Int. J. Gynecol. Cancer. 2010; 20: 1284-1289
- Minimally invasive surgery in gynecologic oncology: laparoscopy versus robotics.Gynecol. Oncol. 2008; 111 (11//): S29-S32
- A phase III randomized clinical trial comparing laparoscopic or robotic radical hysterectomy with abdominal radical hysterectomy in patients with early stage cervical cancer.J. Minim. Invasive Gynecol. 2008; 15: 584-588
- “ Learning curve” robotic radical hysterectomy compared to standardized laparoscopy assisted radical vaginal and open radical hysterectomy.Ceska Gynekol. 2013; 78: 20-27
- Hospital costs for robot-assisted laparoscopic radical hysterectomy and pelvic lymphadenectomy.Gynecol. Oncol. 2013; 130: 95-99
- Robotic-assisted laparoscopic radical hysterectomy (Piver type III) with pelvic node dissection—case report.Eur. J. Gynaecol. Oncol. 2005; 27: 531-533
- Robotic radical hysterectomy in early‐stage cervical carcinoma patients, comparing results with total laparoscopic radical hysterectomy cases. The future is now?.Int. J. Med. Rob. Comput. Assist. Surg. 2007; 3: 224-228
- Robot-assisted laparoscopic radical hysterectomy: comparison with total laparoscopic hysterectomy and abdominal radical hysterectomy; one surgeon's experience at the Norwegian Radium Hospital.Gynecol. Oncol. 2011; 121: 600-604
- Radical hysterectomy: a comparison of surgical approaches after adoption of robotic surgery in gynecologic oncology.Gynecol. Oncol. 2011; 123: 333-336
- Robotics versus laparoscopic radical hysterectomy with lymphadenectomy in patients with early cervical cancer: a multicenter study.Ann. Surg. Oncol. 2011; 18: 2622-2628
- Laparoscopic versus robotic radical hysterectomy after neoadjuvant chemotherapy in locally advanced cervical cancer: a case control study.Eur. J. Surg. Oncol. 2015; 41: 142-147
- Comparative effectiveness of minimally invasive and abdominal radical hysterectomy for cervical cancer.Gynecol. Oncol. 2012; 127: 11-17
- Surgical outcomes of robotic radical hysterectomy using three robotic arms versus conventional multiport laparoscopy in patients with cervical cancer.Yonsei Med. J. 2014; 55: 1222-1230
- The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-analyses.2000
- Estimating the mean and variance from the median, range, and the size of a sample.BMC Med. Res. Methodol. 2005; 5: 13
- Meta-analysis in clinical trials.Control. Clin. Trials. 1986; 7: 177-188
- Quantifying heterogeneity in a meta‐analysis.Stat. Med. 2002; 21: 1539-1558
- Version 53 Copenhagen: The Nordic Cochrane Centre.The Cochrane Collaboration. 2014
- Fertility sparing surgery for treatment of early-stage cervical cancer: open vs. robotic radical trachelectomy.Gynecol. Oncol. 2012; 124: 276-280
- Cost comparison among robotic, laparoscopic, and open hysterectomy for endometrial cancer.Obstet. Gynecol. 2010; 116: 685-693
- A comparative study of 3 surgical methods for hysterectomy with staging for endometrial cancer: robotic assistance, laparoscopy, laparotomy.Am. J. Obstet. Gynecol. 2008; 199: 360.e1-360.e9
- Laparoscopic versus robotic radical hysterectomy after neoadjuvant chemotherapy in locally advanced cervical cancer: a case control study.Eur. J. Surg. Oncol. 2013; 41: 142-147
- Robotic radical hysterectomy versus total laparoscopic radical hysterectomy with pelvic lymphadenectomy for treatment of early cervical cancer.JSLS. 2008; 12: 227-237
- Five classes of extended hysterectomy for women with cervical cancer.Obstet. Gynecol. 1974; 44: 265-272
- Classification of radical hysterectomy.Lancet Oncol. 2008; 9: 297-303
- Meta‐analysis of observational studies on the safety and effectiveness of robotic gynaecological surgery.Br. J. Surg. 2010; 97: 1772-1783
- Robotic-assisted hysterectomy for endometrial cancer compared with traditional laparoscopic and laparotomy approaches: a systematic review.Obstet. Gynecol. 2010; 116: 1422-1431
- Robot-assisted hysterectomy compared to open and laparoscopic approaches: systematic review and meta-analysis.Arch. Gynecol. Obstet. 2013; 287: 907-918
Article info
Publication history
Published online: June 06, 2015
Accepted:
June 5,
2015
Received in revised form:
June 1,
2015
Received:
March 26,
2015
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
